Elevate Module 4

What medication would the nurse anticipate for the treatment of hypothyroidism? A. Levothyroxine B. Methimazole C. Potassium iodine D. Propylthiouracil

A B, C, D = hyperthyroidism

What is the nursing priority for the client experiencing hyperparathyroidism? A. Continuous cardiac monitoring B. Initiate fall precautions C. Admin IV NS D. Begin preparations for emergency parathyroidectomy

A Life threatening complications such as airway obstruction and cardiac arrest may occur from severely high levels of calcium

A client who has diabetes calls the nurse hot line reporting shakiness, nervousness and palpitations. Which question would yield info that would help the nurse decide that this is a hypoglycemic episode? SATA A. what have you eaten today and at what times? B. are you using insulin as a treatment and if so what kind? C. do you feel hungry? D. do you have access to a glucose monitor to check your current glucose level? E. does your skin feel hot and dry?

A, B ,C, D

A client has been receiving 5-fluorouacil treatments for colon cancer and is admitted with weakness, fatigue, thrombocytopenia and low grade fever. Which actions would be appropriate for this client? SATA A. Have dedicated supplies in room B. Place in private room C. Provide high-calorie, high-protein diet D. Limit visitors E. Provide soft bristled toothbrush F. Initiate airborne precautions

A, B, C, D, E

The nurse recognizes which manifestation as a s/s of Hodgkin's lymphoma? SATA A. Drenching night sweats B. Dry, itchy skin C. Painless lymph noes in the neck D. Weight loss of 2 kg in 1 wk E. Pale skin F. Enlarged spleen

A, B, C, E, F 2 kg is not significant weight loss

A client's ANC is 950. Which should the nurse teach the client due to this lab value? SATA A. Avoid people who are sick B. Wear a face mask when going out in public C. Eat only well-done meat, fish and eggs D. Eat iron-rich foods E. Shower or bathe every other day F. Wear gloves when handling pet wastes

A, B, C, F Prevent infection since they are at risk

A client has been prescribed levothyroxine sodium. What should the nurse teach the client about this med? SATA A. Therapy will last a lifetime B. Notify HCP of chest discomfort C. Take med with breakfast D. Do not take with iron supplement E. Improvement of symptoms will occur in days

A, B, D Chest discomfort = possible MI Take on empty stomach Can take several weeks for symptoms to improve

The nurse is providing foot care for a patient who has diabetes. What should the nurse include in the teaching? SATA A. Wear socks specifically made for clients with diabetes B. Wash feet daily with sponge C. Use a moisturizer daily on feet and toes D. Apply medicated pads to treat corns E. Only walk barefoot while in the home F. Shake out shoes and feel the inside before wearing

A, B, F Moisturize feet but not in between toes Never treat corns or calluses themselves (see HCP) Never walk barefoot

A client with a severe cough is suspected of having lung cancer. When preparing the client for testing to confirm a diagnosis of cancer, which tests should a nurse anticipate? SATA A. CXR B. ABG C. Bronchoscopy D. CT E. Pulmonary function test

A, C, D

An oncology client with a Hickman catheter is being discharged to receive chemo via cassette pump at home. The nurse is aware that discharge instructions should include what info? SATA A. always use 2 pairs of gloves when preparing chemo meds B. discarded chemo cassettes and tubing can be placed in regular trashed C. used needles or syringes must be placed into plastic chemo receptacle D. linens soiled with chemo drugs can be washed with regular laundry E. waste is placed into chemo bags and picked up by medical supplier F. regular home cleaning products are appropriate for spilled chemo meds

A, C, E

What s/s would the nurse expect to find in a client admitted to the unit with Addison's disease? SATA A. Salt cravings B. Buffalo hump C. Body hair loss D. Acne E. Hyperpigmentation F. Hypotension

A, C, E, F Buffalo hump and acne = cushing's

Which client instructions are important when the client is scheduled for a VMA test? SATA A. Desserts should not be eaten within 72 hrs prior to the test B. A 24 hr urine specimen requires starting with a full bladder C. Physical exercise should be continued throughout the test D. Avoid all commercially prepared foods for 24 hrs prior to testing E. A preservative will be added to the collection container

A, E Sweets with caffeine and vanilla will alter the test Decrease stress (avoid exercise) to not alter levels

A client receiving chemotherapy for lung cancer reports increased fatigue. The family confirms client is sleeping most of the day and night. What priority action would the nurse take? A. discuss the risks of immobility with client and family B. check current lab values of H&H C. suggest family seek counseling for the client's depression D. request a referral for physical therapy

B

A female client receiving chemo for breast cancer reports vomiting, stomatitis, and a 10-pound weight loss over the past month. The HCP orders an antiemetic and daily mouthwashes. When the home care nurse evaluates the client one week later, what change described by the client would best indicate improvement? A. eating 3 meals daily B. weight gain of 2 pounds C. no further mouth pain D. improved skin turgor

B

A 15 y/o found unresponsive in the park is brought into the ED. The nurse sees a medical alert bracelet stating "diabetic" and notes a fruity smell to the breath. There is no family members available to obtain consent for treatment and attempts to call them have been unsuccessful. What action should the nurse take? A. Obtain consent from the social worker on duty in the ED B. Begin treatment by inserting 2 large bore IVs for admin of NS C. Give glucagon IM and wait for arrival of a parent to consent to further treatment D. Notify HCP

B Consent is not needed in the case of emergency Glucagon is not needed

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? A. Hypernatremia B. Hypokalemia C. Hypocalcemia D. Hypophosphatemia

B Insulin causes movement of K into the cells, which can lead to a severe reduction of serum K if not regulated properly and can be fatal

A client with a long-standing history of diabetes present to the ED with a serum blood glucose of 400. What lab data for this client are consistent with DKA? SATA A. Serum Na 140 B. Ketonuria C. Serum K 5.5 D. PaCO2 52 E. PH 7.35

B, C PaCO2 will go down with increased RR Normal pH (will be low in DKA)

What medications would the nurse anticipate for treatment of hyperthyroidism? SATA A. levothyroxine B. methimazole C. propranolol D. iodine components E. calcitonin

B, C, D b = antithyroid drug c = beta blocker to help with HR and anxiety d = decrease size and vascularity of thyroid gland

What s/s would the nurse expect to find in a client admitted to the unit with a diagnosis of Cushing's disease? SATA A. Hyperpigmentation B. Buffalo hump C. Hirsutism D. Acne E. Moon face F. Hypotension

B, C, D, E Hyperpigmentation = addison's (too little cortisol) HTN occurs with cushing's, not hypotension

Which intervention should a nurse discuss with a client for prevention and early detection of skin cancer from exposure to UV light? A. Use sunscreen with SPF of 10 when outside B. Stay in the shade when outdoors C. Wear wide brimmed hats when outdoors D. Examine skin monthly for changes E. Wear long sleeves and pants when working outdoors

B, C, D, E Use SPF of 30 or higher

The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate to the nurse that a client has received excessive mineralocorticoid replacement? SATA A. oily skin B. weight gain of 4 pounds in one week C. loss of muscle mass in the extremities D. blood glucose of 58 E. serum potassium of 3.2

B, E

The charge nurse has received report from the ED about a client diagnosed with Cushing's disease being admitted to the unit. Which client in a semi-private room would be appropriate for the charge nurse to have this client share? A. client who has leukemia B. client diagnosed with gastroenteritis C. client who has a fractured hip D. client diagnosed with bronchitis

C

The nurse is caring for a newly diagnosed diabetic in HHNK state. What does the nurse anticipate the immediate treatment plan for this client will include? A. NPH insulin B. potassium 40 mEq slow IV push C. IV admin of isotonic saline D. IV sodium bicarbonate

C

Which client diagnosis would a prescription for IV infusion of 1000 mL NS with 20 mEq KCl be appropriate? A. Major burn injury B. Kidney disease C. Abdominal cramping with diarrhea D. DKA E. Hypokalemia

C, D, E Diarrhea = loss of K Insulin treatment in DKA can cause hypokalemia Burns = Hyperkalemia Kidney disease = sodium and potassium retention

A middle-aged client has a strong positive family history for type 2 DM. What should the nurse teach this client regarding the best method to prevent/delay the development of the disease? SATA A. test serum glucose values monthly B. avoid starches and sugar in the diet C. obtain a normal body weight D. maintain a normal serum lipid panel E. exercise regularly

C, E

A client has been on the nursing unit for 2 hours following a retropubic prostatectomy for the treatment of prostate cancer. The client is receiving a CBI of NS infusing at 1000 mL/hr. The client's urine output for the past 2 hours is 410 mLs. What intervention would be best for the nurse to initiate first? A. inspect the catheter tubing for obstruction B. irrigate the catheter with a large piston syringe C. notify HCP D. stop the irrigation flow

D

A homecare client with terminal cancer is taking morphine sulfate and reports the current dose is no longer relieving the pain. What would the nurse tell the client about the increased discomfort? A. the pain meds will need to be taken consistently around the dock B. a different pain med will need to be prescribed since addiction has occurred C. as the cancer spreads, the pain meds will no longer help D. a tolerance to the current dose has occurred, so the dose will need to be increased

D

The nurse is caring for a poorly controlled Type 2 diabetic. Lab results include a BUN of 22 and a Creatinine of 1.9. The nurse checks a blood sugar and it is 218. The client is currently taking metformin and exenatide. What is the priority concern because the client is taking metformin? A. metformin is not controlling the blood sugar B. metformin can cause GI complaints C. metformin can cause a decrease in appetite D. metformin is contraindicated with an elevate Creatinine level

D

What info should the nurse include in teaching an oncology client the purpose of taking epoetin? A. emergency treatment of anemia B. improves quality of life C. used for the prevention of pure red cell aplasia D. decreases the need for transfusion

D

What is the priority nursing assessment for a client post-op thyroidectomy? A. 5 mm dark red drainage B. Temp 99 F C. Trousseau's sign negative D. Stridor

D Vocal edema causes Stridor within 24 hours post-op

Brachytherapy: T/F client may ambulate ad lib

F

Brachytherapy: T/F visitors should stay no longer than 10 minutes

F 30 mins/day

Mastectomy: T/F may wear a watch on affected side

F causes compression, nothing goes on the affected side

Brachytherapy: T/F Radioactive for 1 week

F generally 24-48 hrs

Mastectomy: T/F keep affected arm at the level of the heart in the post-op period

F may have swelling, elevate affected arm

Mastectomy: T/F have client avoid looking at incision

F they need to look at it for coping and adapting to body image

Preventative Screenings for Cancer

Female monthly self breast exam mammograms (age 40+) annual pelvic and breast exam pap smear (1-3 yrs) Male monthly self breast and testicular exams digital rectal and PSA (age 50+) Both colonoscopy (age 50, then every 10 yrs) annual fecal occult blood

Brachytherapy: T/F Nurses should only care for one implant client per shift

T

Brachytherapy: T/F clients should have an indwelling catheter

T

Brachytherapy: T/F decrease fiber in diet of client

T

Brachytherapy: T/F mark the room with instructions for specific isotope

T

Brachytherapy: T/F no pregnant visitors

T

Brachytherapy: T/F nurses must always wear a film badge

T

Brachytherapy: T/F visitors must stay at least 6 ft from source

T

Mastectomy: T/F avoid sunburn

T

Mastectomy: T/F flex and extend arm on affected side

T

Mastectomy: T/F no injections in the affected arm

T

Mastectomy: T/F use affected arm to brush hair

T

Brachytherapy: T/F Given IV or PO

T

Mastectomy: T/F no nail biting

T

A client with acute pancreatitis prescribed TPN, methylprednisolone and sliding scale insulin. What is the rationale for the insulin prescribed? SATA A. Impaired endocrine function of the pancreas B. Inability of the liver to convert glucose C. Stead therapy SE D. Dextrose concentration of TPN E. Re-establish serum K+ level

A, C, D

A client post thyroidectomy has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high? SATA A. irritability B. weight gain C. tachycardia D. tremors E. headache F. bradycardia

A, C, D, E

What is the priority electrolyte imbalance for the nurse to monitor when caring for a client post op thyroidectomy? A. Hypercalcemia B. Hyperkalemia C. Hypocalcemia D. Hypomagnesemia

C Can cause possible injury/removal of parathyroid glands which can drop calcium levels

What is the priority assessment for a client post-op thyroidectomy? A. mental status changes B. carpal spasm C. patency of airway D. pain at incision site

C put o2, suction equipment and trach in the room

What should the nurse include in the teaching pan for a client receiving external beam radiation? SATA A. Small marks will be placed on the skin to mark the treatment area B. Lotion may be used around the treatment area to decrease dryness C. The radiation therapist can see, hear and talk with you at all times during the treatment D. The machine will make clicking and whirring noises E. You can breathe normally during radiation treatment F. You will not become radioactive

A, C, D, E, F Do not put lotion, powder or deodorant near or on treatment area

A nurse is assigned a client who is one day post thyroidectomy. While taking the BP, the client's hand starts to tremble. What actions should the nurse take? SATA A. Pad the side rails B. Monitor K level C. Take BP in opposite arm D. Place trach set at bedside E. Check for airway patency F. Assess heart rhythm

A, D, E, F Worried about Ca levels, not K Seizure precautions

While preparing to administer IV chemo the nurse accidently pulls the tubing apart, spilling the solution onto the floor. After clamping the tubing, what is the nurse's immediate action? A. use disposable towels to clean up the liquid B. obtain spill kit specific to this type of solution C. complete an incident report for supervisor D. call housekeeping to help clean up the floor

B

A client with cushing's disease is in a semi-private room. When considering room assignments, which client would be the safest choice to assign to the room? A. Newly admitted client with MRSA B. Client with chronic kidney disease C. Client who is post emergency cholecystectomy D. Client with full thickness burn of left leg

B CKD is not infectious and would be the best for the immunosuppressed patient (due to excessive secretion of glucocorticoids)

Mastectomy: T/F no BP on affected side

T

Mastectomy: T/F wear gloves when gardening

T

After completing several rounds of chemo, a client's lab results indicate severe neutropenia. Following the admission assessment, what is the nurse's priority action for the client? A. place handwashing sign on the client's door B. avoid all venipunctures or IM injections C. have client wear mask when leaving room D. instruct client to use a soft toothbrush

A

What is priority for the client experiencing hyperparathyroid crisis? A. Support for airway and breathing B. Continuous cardiac monitoring for arrhythmias C. Provide safety precautions D. Prepare for emergency trach

A

A nurse is caring for a poorly controlled DMT2 client. The client does not adhere to the diet and the latest A1c is 8%. The serum glucose at this visit is 218. The client is currently taking metformin and exenatide. Based on this history, what should the nurse anticipate will be the first strategy implemented to improve glucose control for this client? A. Nutritional counseling B. Increased daily exercise program C. Education regarding insulin by basal/bolus dosing method D. More frequent self-monitoring of blood glucose

A Patient is noncomplaint!

Type 1 vs Type 2 Diabetes

Type 1 early onset DKA insulin dependent Type 2 sedentary lifestyle and excess weight treat with diet and exercise oral hypoglycemics and/or insulin HHNK Both sick pancreas cannot utilize glucose

Dietary Iodine

essential component of T3 and T4

A client is being admitted with new onset hyperthyroidism. Which medication is of concern to the nurse while reviewing the client's routine medications? A. Cimetidine B. Furosemide C. Amiodarone D. Propranolol

Amiodarone can cause thyroid dysfunction (high in iodine)

Risk Factors of Cancer

alcohol tobacco age immunosuppression diet (red meat, low fiber, etc.) heredity chemical exposure radiation excessive hormones sun exposure

Pharmacologic Iodine

cause temporary (2-4 weeks) slowing of iodine uptake by the thyroid (won't produce as much as thyroid hormone, treats hyperthyroidism)

Metformin

glucophage oral hypoglycemic biguanide major SE: increased gastric emptying (diarrhea) first line treatment for DM2

Hyperthyroidism S/S

nervous weight loss sweaty/hot exophthalmos decreased attention span increased appetite irritable increased BP enlarged thyroid increased GI motility